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Hawaii

INTRODUCTION

Currently, 1.9 million people are living with limb loss in the United States, with an average of 507 people continuing to lose a limb every day. This results in an estimated 185,000 amputations per year (1), and this number is expected to double by the year 2050 due to increasing rates of diabetes and vascular disease (1). Among those living with limb loss, the major causes of their amputations are vascular disease (54%) – including diabetes and peripheral arterial disease – trauma (45%) and cancer (less than 2%) (2). The most common causes of pediatric amputations, however, are lawn mower accidents (3). Non-whites comprise about 42% of the limb loss population in the U.S. (1). In 2008, the diabetes related amputation rate among African Americans was nearly four times that of whites (4).

A total of 631 amputations were performed in Hawaii hospitals in 2013. These amputations were performed for a variety of reasons, including diabetes and peripheral arterial disease complications. The following information details the trends and most current rates of amputation and diabetes in Hawaii.

1. AMPUTATION TRENDS OVER TIME

According to hospital discharge data, the number of total amputations performed in Hawaii was at a low in 1997 (528) and a high in 2007 (707). This overall time period represents a 19.51% increase. A total of 10,658 amputations were performed in this time period. (See Graph 1.1)

In Hawaii, the total number of upper-extremity amputations performed from 1997 to 2013 was 716. The year 2005 saw the most of these amputations (55), while the lowest incidence (34) occurred in 1998. This time period represents a15.38% decease. (See Graph 1.2)

A total of 9,942 of lower-extremity amputations were performed from 1997 to 2013. The incidences of these amputations were at their highest in 2007 (655) and their lowest in 1997 (476). This represents a, 23.32% increase in the number of lower-extremity amputations from 1997 to 2013. (See Graph 1.3)

2. Types of Amputations Performed

105 upper-extremity amputations were reported in 2013. The most common minor upper-extremity amputation was of the fingers (92) and no major upper-limb amputation procedures were reported (See Graph 2.1)

1,511 lower-extremity amputations were performed in 2013. In terms of minor lower-extremity amputations, toes (734) were amputated more often than part of the foot (233). For major lower-extremity amputations, below-knee (351) amputation was the most common procedure, followed by above-knee (179) procedures. (See Graph 2.2)

3. WHO LOSES A LIMB?

In 2013, most amputations were performed on individuals aged 45-64 years old, closely followed by the age group of 65-84 year olds (See Graph 3.1).

We can see that the African American population of Hawaii bears the heaviest burden of amputation (0.059% of the African American population underwent amputations). This is evident when compared with the percentage of the white population that underwent amputations (0.036%) and amputations in the state’s population as a whole (0.044%). Because Hawaii’s Asian and Pacific Islander population was calculated together, percentages are unavailable for these groups. (See Graph 3.4)

4. DIABETES TRENDS

In 2013, a total of 91,981 Hawaii residents indicated that they had been diagnosed with diabetes at some point in their lives. The prevalence of diabetes in the adult population of Hawaii increased 178.8% from 1994 to 2013. Data from 2004 in unavailable. (See Graph 4.1)

The annual rate of existing cases of diabetes among adults in Hawaii decreased 70.45% from 1994 to 2013. Data from 2004 is unavailable. (See Graph 4.2)

5. HEALTHCARE COSTS

For persons with a unilateral lower-extremity amputation, the two year healthcare costs, including initial hospitalization, inpatient rehabilitation, outpatient physical therapy, and purchase and maintenance of a prosthetic device, is estimated to be $91,106. The lifetime healthcare cost for persons with a unilateral lower extremity amputation is estimated to be more than $500,000 (5).

It is anticipated that these healthcare costs would be higher for a person with a proximal amputation level and bilateral amputation status, due to higher prosthetic costs. Charges represent what the hospital billed for the case, and may not represent all discharges for amputations. (See graph 5.1)

5. MacKenzie EJ. Health-Care Costs Associated with Amputation or Reconstruction of a Limb-Threatening Injury. The Journal of Bone and Joint Surgery (American)2007;89(8):1685.

It is not the intention of the Amputee Coalition to provide specific medical or legal advice but rather to provide consumers with information to better understand their health and healthcare issues. The Amputee Coalition does not endorse any specific treatment, technology, company, service or device. Consumers are urged to consult with their healthcare providers for specific medical advice or before making any purchasing decisions involving their care.

National Limb Loss Resource Center, a program of the Amputee Coalition, located at 900 East Hill Ave., Suite 390, Knoxville, TN 37915 | 888/267-5669

This Web site was supported, in part, by grant number 90LL0002-03-00 and 90LL0002-03-01, from the Administration for Community Living, U.S. Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.